RESUMO
As medicine is moving toward performance and outcome-based payment and is transitioning away from productivity-based systems, value is now being appraised in healthcare through "performance measures." Over the past few decades, assessment of clinical performance in health care has been essential in ensuring safe and cost-effective patient care. The Centers for Medicare & Medicaid Services is further driving this change with measurable, outcomes-based national payer incentive payment systems. With the continually evolving requirements in health care reform focused on value-based care, there is a growing concern that clinicians, particularly dermatologists, may not understand the scientific rationale of health care quality measurement. As such, in order to help dermatologists understand the health care measurement science landscape to empower them to engage in the performance measure development and implementation process, the first article in this 2-part continuing medical education series reviews the value equation, historic and evolving policy issues, and the American Academy of Dermatology's approach to performance measurement development to provide the required foundational knowledge for performance measure developers.
Assuntos
Medicare , Qualidade da Assistência à Saúde , Idoso , Humanos , Estados Unidos , Atenção à Saúde , Reforma dos Serviços de Saúde , Instalações de SaúdeRESUMO
Throughout the 21st century, national and local governments, private health sectors, health insurance companies, healthcare professionals, labor unions, and consumers have been striving to develop an effective approach to evaluate, report, and improve the quality of healthcare. As medicine improves and health systems grow to meet patient needs, the performance measurement system of care effectiveness must also evolve. Continual efforts should be undertaken to effectively measure quality of care to create a more informed public, improve health outcomes, and reduce healthcare costs. As such, recent policy reform has necessitated that performance systems be implemented in healthcare, with the "performance measure" being the foundation of the system in which all of healthcare must be actively engaged in to ensure optimal care for patients. The development of performance measures can be highly complex, particularly when creating specialty-specific performance measures. To help dermatologists understand the process of creating dermatology-specific performance measures to engage in creating or implementing performance measures at the local or national levels, this article in the two-part continuing medical education series reviews the types, components, and process of developing, reviewing, and implementing performance measures.
Assuntos
Dermatologia , Humanos , Atenção à Saúde , Seguro SaúdeRESUMO
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the United States population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.
Assuntos
Terapias Complementares/métodos , Fármacos Dermatológicos/administração & dosagem , Dermatologia/métodos , Psoríase/terapia , Academias e Institutos/normas , Administração Cutânea , Terapia Combinada/métodos , Terapia Combinada/normas , Terapias Complementares/normas , Dermatologia/normas , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Fundações/normas , Humanos , Educação de Pacientes como Assunto/normas , Psoríase/diagnóstico , Índice de Gravidade de Doença , Resultado do Tratamento , Estados UnidosRESUMO
Psoriasis is a chronic, multisystem, inflammatory disease that affects approximately 1% of children, with onset most common during adolescence. This guideline addresses important clinical questions that arise in psoriasis management and provides evidence-based recommendations. Attention will be given to pediatric patients with psoriasis, recognizing the unique physiology, pharmacokinetics, and patient-parent-provider interactions of patients younger than 18 years old. The topics reviewed here mirror those discussed in the adult guideline sections, excluding those topics that are irrelevant to, or lack sufficient information for, pediatric patients.
Assuntos
Produtos Biológicos/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Metotrexato/uso terapêutico , Fotoquimioterapia , Psoríase/tratamento farmacológico , Psoríase/epidemiologia , Adolescente , Corticosteroides/uso terapêutico , Antralina/uso terapêutico , Inibidores de Calcineurina/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Criança , Pré-Escolar , Alcatrão/uso terapêutico , Comorbidade , Ciclosporina/uso terapêutico , Dislipidemias/epidemiologia , Medicina Baseada em Evidências , Humanos , Lactente , Recém-Nascido , Doenças Inflamatórias Intestinais/epidemiologia , Resistência à Insulina , Saúde Mental , Síndrome Metabólica/epidemiologia , Ácidos Nicotínicos/uso terapêutico , Obesidade/epidemiologia , Psoríase/psicologia , Retinoides/uso terapêuticoRESUMO
Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 2% of the world's population. In this guideline, we focus the discussion on systemic, nonbiologic medications for the treatment of this disease. We provide detailed discussion of efficacy and safety for the most commonly used medications, including methotrexate, cyclosporine, and acitretin, and provide recommendations to assist prescribers in initiating and managing patients on these treatments. Additionally, we discuss newer therapies, including tofacitinib and apremilast, and briefly touch on a number of other medications, including fumaric acid esters (used outside the United States) and therapies that are no longer widely used for the treatment of psoriasis (ie, hydroxyurea, leflunomide, mycophenolate mofetil, thioguanine, and tacrolimus).
Assuntos
Psoríase/tratamento farmacológico , Acitretina/uso terapêutico , Ciclosporina/uso terapêutico , Monitoramento de Medicamentos , Humanos , Metotrexato/uso terapêutico , Piperidinas/uso terapêutico , Pirimidinas/uso terapêutico , Talidomida/análogos & derivados , Talidomida/uso terapêuticoRESUMO
In our evolving health care system, dermatologists are increasingly being asked to prove the value of care they provide to patients with severe skin diseases. Current quality measures for inflammatory dermatoses have limited validity and feasibility. Through collaboration and a modified Delphi process, International Dermatology Outcome Measures and the American Academy of Dermatology sought to reach consensus on a valid and feasible provider-assessed global disease severity metric to be incorporated into a quality measure for inflammatory dermatoses. To inform the modified Delphi process, a review of the literature was performed, and data were collected on current provider-assessed global disease severity metrics. After literature review, 36 members of International Dermatology Outcome Measures and the American Academy of Dermatology participated in the modified Delphi process to reach consensus on features of the metric. Psoriasis, atopic dermatitis, and acne achieved overwhelming consensus for inflammatory dermatoses that could be measured in a global disease severity metric. Consensus was also reached on the use of a 5-point ordinal scale with descriptors provided through referenced electronic platforms. Expert development of quality measures incorporating this metric and its inclusion in data collection platforms are critical to enabling dermatologists to prove the value of care provided to patients with severe inflammatory dermatoses.
Assuntos
Avaliação de Resultados em Cuidados de Saúde , Indicadores de Qualidade em Assistência à Saúde , Índice de Gravidade de Doença , Dermatopatias/terapia , Acne Vulgar/terapia , Consenso , Técnica Delphi , Dermatite Atópica/terapia , Humanos , Psoríase/terapia , Literatura de Revisão como AssuntoRESUMO
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations on the basis of available evidence.
Assuntos
Doenças Cardiovasculares/epidemiologia , Saúde Mental , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Papel do Médico , Psoríase/epidemiologia , Psoríase/psicologia , Qualidade de Vida , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/epidemiologia , Comorbidade , Dislipidemias/epidemiologia , Medicina Baseada em Evidências , Humanos , Hipertensão/epidemiologia , Doenças Inflamatórias Intestinais/epidemiologia , Nefropatias/epidemiologia , Estilo de Vida , Hepatopatias/epidemiologia , Pneumopatias Obstrutivas/epidemiologia , Neoplasias/epidemiologia , Educação de Pacientes como Assunto , Psoríase/terapia , Síndromes da Apneia do Sono/epidemiologiaRESUMO
Psoriasis is a chronic, inflammatory multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations based on the available evidence. The treatment of psoriasis with biologic agents will be reviewed, emphasizing treatment recommendations and the role of the dermatologist in monitoring and educating patients regarding benefits as well as associated risks.
Assuntos
Produtos Biológicos/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Psoríase/tratamento farmacológico , Adalimumab/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Medicamentos Biossimilares/uso terapêutico , Certolizumab Pegol/uso terapêutico , Quimioterapia Combinada , Etanercepte/uso terapêutico , Medicina Baseada em Evidências , Humanos , Infliximab/uso terapêutico , Piperidinas/uso terapêutico , Pirimidinas/uso terapêutico , Pirróis/uso terapêutico , Ustekinumab/uso terapêuticoRESUMO
Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 3.2% of the world's population. In this section of the guidelines of care for psoriasis, we will focus the discussion on ultraviolet (UV) light-based therapies, which include narrowband and broadband UVB, UVA in conjunction with photosensitizing agents, targeted UVB treatments such as with an excimer laser, and several other modalities and variations of these core phototherapies, including newer applications of pulsed dye lasers, intense pulse light, and light-emitting electrodes. We will provide an in-depth, evidence-based discussion of efficacy and safety for each treatment modality and provide recommendations and guidance for the use of these therapies alone or in conjunction with other topical and/or systemic psoriasis treatments.
Assuntos
Dermatologia/normas , Fototerapia/normas , Guias de Prática Clínica como Assunto , Psoríase/terapia , Academias e Institutos/normas , Fundações/normas , Humanos , Metanálise como Assunto , Fototerapia/instrumentação , Fototerapia/métodos , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Estados UnidosRESUMO
BACKGROUND: The American Society of Plastic Surgeons commissioned the multidisciplinary Performance Measure Development Work Group on Reconstruction after Skin Cancer Resection to identify and draft quality measures for the care of patients undergoing skin cancer reconstruction. Included stakeholders were the American Academy of Otolaryngology-Head and Neck Surgery, the American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Dermatology, the American Society of Dermatologic Surgery, the American College of Mohs Surgery, the American Society for Mohs Surgery, and a patient representative. METHODS: Two outcome measures and five process measures were identified. The outcome measures included the following: (1) patient satisfaction with information provided by their surgeon before their facial procedure, and (2) postprocedural urgent care or emergency room use. The process measures focus on antibiotic stewardship, anticoagulation continuation and/or coordination of care, opioid avoidance, and verification of clear margins. RESULTS: All measures in this report were approved by the American Society of Plastic Surgeons Quality and Performance Measures Work Group and Executive Committee, and the stakeholder societies. CONCLUSION: The work group recommends the use of these measures for quality initiatives, Continuing Medical Education, Continuous Certification, Qualified Clinical Data Registry reporting, and national quality reporting programs.
Assuntos
Neoplasias Cutâneas , Cirurgiões , Humanos , Neoplasias Cutâneas/cirurgia , Pele , Cirurgia de Mohs , Academias e InstitutosRESUMO
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal-dominant disorder. The disease has been formally characterized with epistaxis, cutaneous and mucosal telangiectases, a first-degree relative with HHT, and visceral lesions such as arteriovenous malformations (AVMs). Hereditary hemorrhagic telangiectasia has been underreported for many years. Wider recognition of this disorder in recent years has prompted researchers and physicians to recognize milder cases and focus on earlier treatment. This article highlights different treatments used to control epistaxis and screen for other complications associated with HHT.